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INTRODUCTION Neuroleptic malignant syndrome (NMS) is a rare, potentially life-threatening reaction to antipsychotic drugs characterized by high fever, muscle rigidity, altered mental status, and autonomic instability. It was first described in 1956 1 reportedly following a reaction to the newly introduced antipsychotic drug chlorpromazine. Interestingly, all neuroleptics have been linked to this condition including newer antipsychotics. Due to similar symptoms, it is debatable if individuals with NMS are highly susceptible to malignant

In February 2019, the pharmaceutical manufacturer, American Regent, Inc (Shirley, NY) reintroduced droperidol to the US drug market. Droperidol is a butyrophenone, the same drug class as the typical antipsychotic agent haloperidol, and acts as a dopamine D2 receptor antagonist producing antiemetic and sedative-hypnotic effects. Not only has it been used along with fentanyl to produce a state of neuroleptic analgesia, previously marketed in combination as Innovar (Janssen Pharmaceutica, Beerse, Belgium) and since discontinued, but it also has

despite palpable central pulses. However, after a bolus of phenylephrine (100 μg), the mean arterial pressure improved to 70 mm Hg. The patient withdrew to painful stimuli on examination. He was intubated after receiving fentanyl and an additional dose of succinylcholine (120 mg). His body temperature was measured as 97.5°F Differentials at that time included underlying cardiac abnormality (such as long QT or structural disease), toxins (serotonin syndrome or neuroleptic malignant syndrome), and hypotensive mediated arrest. Labs were drawn and were grossly normal aside

. 21 Richter , J. J. Current theories about the mechanisms of benzodiazepines and neuroleptic drugs. Anesthesiology 1981 . 54 : 66 – 72 . 22 Sanders , J. C. Flumazenil reverses a paradoxical reaction to intravenous midazolam in a child with uneventful prior exposure to midazolam. Paediatr Anaesth 2003 . 13 : 369 – 370

uncontrolled release of calcium ions, leading to accelerated muscle metabolism and subsequent clinical features that include contracture, rigidity, severe hyperthermia, metabolic acidosis, and tachycardia. In addition to the genetic susceptibility mentioned previously, certain myopathies, including Duchenne Muscular Dystrophy, central core disease, neuroleptic malignant syndrome, and King-Denborough syndrome, present a risk for MH. 15 The most widely used test for determining MH susceptibility is the halothane-caffeine contracture test (CHCT). This test is performed

antidepressants may not experience adequate pain relief from codeine or its derivatives. 7 , 8 Antipsychotic Drugs The psychoses include schizophrenia and other delusional impairments in which patients have difficulty in comprehending reality. These disorders are managed using antipsychotic drugs. Although less descriptive, these agents may also be referred to as “neuroleptics,” a term less offensive to the patient. Despite our poor understanding of their precise mechanisms and their myriad side effects, it cannot be disputed that